Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5860
Peer-review started: February 25, 2021
First decision: May 1, 2021
Revised: May 17, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: July 26, 2021
A nomogram is an effective tool to predict patient outcomes intuitively. Lymph node (LN) metastasis and tumor deposit (TD) conditions affect the prognosis of patients with colorectal cancer (CRC) after surgery markedly. At present, establishing an effective tool to predict the overall survival (OS) of CRC patients after surgery is necessary.
To establish a predictive model to assess the prognosis of CRC patients after surgery.
To screen out the suitable risk factors that can affect the OS of CRC patients after surgery and establish a nomogram with these factors.
A total of 3139 patients diagnosed with CRC after surgery from the Surveillance, Epidemiology, and End Results program were divided into a training set (n = 2029) and a validation set (n = 1047) randomly. The Harrell concordance index (C-index), Akaike information criterion, and area under the curve (AUC) were used to assess the predictive efficacy of the N stage from the American Joint Committee Cancer tumor-node-metastasis classification, LN ratio, and log odds of positive lymph nodes (LODDS). Construction of the nomogram was based on the risk factors screened out through univariate and multivariate analyses. The C-index, receiver operating characteristic (ROC) curve, calibration curve, and likelihood ratio test were used to assess the final nomogram.
Seven independent predictive factors, namely, race, age at diagnosis, T stage, M stage, LODDS, TD condition, and serum carcinoembryonic antigen level, were included in the nomogram. The C-index of the nomogram for OS prediction was 0.8002 (95%CI: 0.7839-0.8165) in the training set and 0.7864 (95%CI: 0.7604-0.8124) in the validation set. The AUC values of the ROC curve predicting the 1-, 3-, and 5-year OS were 0.846, 0.841, and 0.825, respectively, in the training set and 0.823, 0.817, and 0.835, res
The nomogram incorporating LODDS, TD, and other risk factors shows a great predictive accuracy and better sensitivity and specificity and represents a potential tool for therapeutic decision-making.
Suitable combination of LODDS and TD is necessary to simplify the nomogram. Larger sample size studies are required to include more potential risk factors, improve the nomogram, and stratify the prognosis further.